The URL can be used to link to this page

Home My WebLink About0070 OXNER ROAD - Health 5 OXNER ROAD,CENi'ERVILLE A= 193115 • till =J�FECY�(fpCOm Aff UPC 12543 HASTINGS,MN TOWN OF BARNSTABLE LOCATION 70 0 ►ye-vt I�GQ SEWAGE # P® VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. (-'4,K—LA O SEPTIC TANK CAPACITY 'E cr,I�,V 50-(�� nn . I LEACHING FACILITY:(type) .;1'�'�"G ( (size ) Z fs✓ NO. OF BEDROOMS PRIVATE WELL ORUBLIC WAR BUILDER OR OWNER u} DATE PERMIT ISSUED: , �- DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No J ' THE COMMONWEALTH OF MAST,k1CHU ETTS BOARD OF HEALTH APP , - TOWN OF BARNSTABLE Appliration for Disposal Works Cann Application is hereby made for a Permit to Construct ( ) or Repair ( L-)"an Individual Sewage Disposal System at: ..............`.7.Q........ --_ _Qc ............... .................... ekt...--------•----•------.........----........---..........------. Location-Address or Lot No. l?=-tJ 1( ?r .1.. .0-c �9�....................... .......... ...... �L- Owner Address Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms..... ..................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ------------_______________ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ............................................................... W Design Flow.......... .......................gallons per person per day. Total daily flow----- .......................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width......__....._...... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.______ r pag __:___..._._ Diameter.__..lIL2.__..... Depth below inlet_..____.....___.. Total leaching area..................sq. ft. Z Other Distribution box' ( ) Dosing tank ( ) aPercolation Test Results Performed b . Date. 4 Test Pit No. 1....i..........minutes per inch Depth of Test Pit.................... Depth to ground water........................ �r4 Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water........................ 0 a ..........-.................................................................................................................................................. Description of Soil...............................................................................--......-----------------------------------------------------------------------......_.. x U ..............................................•-----•-•-•-•-••---••...••-----•••-••----...••---•--•---...--•-•-•--•---•-•-••---••-••-----••-•----••-••--••••••-----•------••-----•-----•-----•-------_.. w x -•-••-•----------------------------•-•••-••-•----------••-••--•----••---•••------••-•---•••.------------------------------------------------ .................................... Nature of Repairs or Altgrations—,/A.nswer when applicable._.:_'1L, ------- .tc_�... '-(s..��.�........ ;�9�➢! 4^�� 1�i4� �cb . !!L r '------------------- .............................................................. Agreement: V The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be issued by the board of health. Signea .................... ............................ .....-- . -------- ------ "d �e�,-� Date Application Approved BYE' �J....�...tc ..... ... 1::7... Date Application Disapproved for the following reasons- --- ------------ ------------ --------------------------------- - - ---------------------- ----- ------------------- ...............................................------------------- --- -- -------- ------ ---------- --- -------- -- --------------- --- -- ----------------- - ------------ -- -- ----------------------------------- Permit No. -------- -;)- lay....................... Issued ..... ...................................................Date ---.. Date Fins......�,J .............. THE COMMONWEALTH OF MAS.5ACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiou for Dispuuttl Works Tonfltr- #tun r rrunt Application is hereby made for a Permit to Construct ( ) or Repair ( Wan Individual Sewage Disposal System at: ..........-• ....... R.aA.4�............... ..•--..............�_�-1:�..i......... ................................................... 0 Location.Address or Lot No. ...............t--r_I in t. ........ eti/...................... .....:........... .............................................................. J Owner -_ Address ..............0M. .�c.�.1.� !4/_... ..�' �.` . !!;.. _:... ti ......9. /_....... ............. .-•........... ._..... Installer ` Address Type of Building Size Lot............................Sq. feet Dwelling—No. ofuildi edrooms.__..�1_...........,.......................Expansion Attic ( ) Garbage Grinder ( ) e Other—Type Q" yp of ding ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures ...................................... •-------.------------ W Design Flow...•.•.. ;;Z.:�....................gallons per person per day. Total daily flow....:=.Z:;�......................gallons. WSeptic Tank—Liquid ca.pacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—N .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.......... ......... Diameter...._!.!?.`...:.. Depth below inlet......b.(......... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Resul Ls Performed by.......................................................................... Date........................................ ,.a Test Pit,No. 1.....I..........minutes per inch Depth of Test Pit.................... Depth to ground water........................ f� Test Pit No. 2.......:........minutes per inch Depth of.Test Pit.................... Depth to ground water........................ 0 a ---•-•---••----•••-------•-•............................••••------•-•-----.......---•--•----•---••-•......................................................... Description of Soil...............................................................................=........................................................................................ V ----------------- ------- •----------------- ------------- --.............. ..__.........---------- ----•------------------------ •------- •--------------------------------------- .....-.----------... W V Nature of Repairs or Alterations—Answer when . f app licable.. '& !�K.O_CA.._....(nA7( A - 1 _{ u _'CC_ :(2_..-rx.. �:_._ : .............•---- _........& ..... `= .............................. Agreement: y, J The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions bf'�TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation.until a Certificate of Compliance has been issued by the board of health. Sign ed �a".� - .......................... Dace ApplicationApproved BY -------------NI ... e ,�...................................................;................ ........ .- r.7...-.. .� Date Application Disapproved for the following reasons: ......-----"--------------------------'---............---.............------........-'-'--------'----...."-'...-'-................ --"----------'--------------'-------...................................................................................................--------...--------............"'.......................... ..........""......I.."'.......... / IV Dace Permit No. C�. .- l p:. Issued .................................' ' Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Certiftrate of C�lox>rtpitrxnre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( j or Repaired ............................................ Installer at ....................................7 ..... ......tr.................----'--- 7`................................................................... has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No.. .......'?9...-..�.p..�............. dated .....�.�...^...................._?� THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE-"----- ....../ '`� ------------------ Ins ecto4 .. ... P v THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ccyy J TOWN OF BARNSTABLE No.;.ls�z =/ FEE. .. Disposal Works Tuuotr iuu. amit Permission is hereby granted...................kl& 0r•c�_S�-t T 1 , --•-•••-•---•......................•-.....-•-...... to Construct ( ) or Repair ( L) an Individual Sewage Disposal System at No Street as shown on the application for Disposal Works Construction Permit '_ Dated.......................................... ----.......•-•••--•--•-----_•---•-... ,. ...................................................._ •...• Board of Health DATE__....*........ ..-...I._.- y5 ................ FORM 36508 HOBBS&WARREN,INC..PUBLISHERS Commonwealth of Massachusetts Executive Office of Environmental Affairs )qL artment ofEnvironmental ProtectionWIIIIsm F.WeldGmemdrTrudyCo Secretary,EOEA David B.Struhs Commissioner , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: -O 0'Y-WOY" 1 - ceti Address of Owner: �a�,r L•� W�r�yrV Date of Inspection: (If different) Name of Inspectors v, Company Name, Address and Telephone Number: CERTIFICATION STATEMENT I certify that I.have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on.-site sewage disposal systems. The system: t/ Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signatur C Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. .If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and.the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sen; to the system owner and copies sent to the buyer, if applicable and the appro\'ing au:hority. INSPECTION SUMMARY: Check A, B, C, or D: A] SYST M PASSES:. 7I have not,found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced.or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate yes, no, or,not determined (Y, N, or ND). Describe basis of determination in all,instances. If"not determined", explain why not) The septic tank is metal, cracked,.structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection'.if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 8/15/95) Winter,. One Winr Street Boston,Massachusetts 02108 • FAX(6/7)556-1049 • Telephone{617)292-SS00 40 Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:-70 QXve-v- Owner,\ Vv"i v ut W a,r c�tty Date of Inspection; B) SYSTEM[[CONDITIONALLY PASSES (continued) ly Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced _ The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed C) FURTHER EVALUATION. IS REQUIRED BY THE BOARD OF HEALTH: I***-I Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND.THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE .ENVIRONMENT: _ 1he sys1em ha, a septic tanK anu son absorption sybrem anu is within i0u feci to a iuifuCe wioicr supp:�y'Gr tributary' to a surface water supply. _ The system har a septic tank and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption-system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or Jess than 5 ppm. D) SYSTEM FAILS: I have determined that the system violates one or more of-the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board.of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded,or clogged SAS or, cesspool. (revised 8/15/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: _Z Q ` Owner: Warsl rU Date of Inspection:, D) SYSTEM FAILS (continued): jo Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow.. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. An onion of a cesspool or privy is within t f f d. y p p p y 00 feet o.a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. t4 Any,portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has-been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia,nitrogen and nitrate nitrogen. E);LARGE SYSTEM FALLS: The following criteria apply to large systems in addition to the criteria above: The design flow of system is 10,000 gpd or greater (large System) and the system is a significant threat to public health, and safety and the environment because one or more of the following conditions exist: _ the system is within 400 feet of a surface drinking water supply the.system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area 0WPA) or a mapped Zone II of a public water supply welly r The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 8/15/95) 3 w�' . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 70 QYv2 f'" C E'w Owner: C-4 Date of Inspection:: Check if the following have been done: Pumping information was requested of the owner, occupant, and Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates d ring.that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. _As built plans have been obtained and examined. Note if they are not available with N/A. The facility or dwelling was inspected for signs of sewage back-up. ZThe system does not receive non-sanitary or industrial waste flow Vfhe site was inspected for signs of breakout. fll system components, excluding the Soil Absorption System, have been located on.the site. _,-*"'The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. LThe size and location of the Soil Absorption System on the site has been determined based on existing information'or Zaproximated b�• non-intrusive methods.occupants, if Viere...t L•nm ovrner} were provided with information on the proper maintenance of Sub Surface.Disposal System. f; (ievised 8/15/951 4 A I e ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: -70 0k00C"' 1 cems= Owner: i UCLV-Sl o-f Date of Inspection: FLOW CONDITIONS RESIDENTIAL Design flow: Ilo s Number of bedrooms: Number of current residents: Garbage grinder (yes or no): � Laundry connected to system (yes or no).,- - Seasonal use (yes or no): Water meter readings, if available: 1� Last date.of occupancy.—ID4 V��C - COMMERCIAUINDUSTRIAL• Type.of establishments Desigm flow: aallons/day Grease trap present:{yes or no)_, Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_, Water meter,readings,.if available: Last date of occupancy: i OTHER: (Describe) Last,date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as pan of inspection: (yes or no)_ If yes, volume pumped: gal)on� Reason for pumping: TYPE 9F SYSTEM 1/ Septic tank/distribution box/soil absorption.system Single cesspool Overflow cesspool Privy Shared system(yes or no): (if yes, attach previous inspection records, if any) Other(explain) APPROXIMATE AGE of all components, date installed (if known) and source of information: Sewage odors detected when arriving at the site: (yes or no) (reYised 8/15/95) 5 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: '7D O"'rNey— k2Q Owner: Lx'r.&rC i k, Date of Inspection: a-.Cp�S� SEPTIC TANK: (locate on site plan) K Depth below grader Material of construction: 1/concrete _metal _FRP—other(explain) Dimensions: Sludge depth: O a 3cl Distance from top ofµudge to bottom of outlet tee or baffle:_ Scum thickness:, �cc Distance from top of scum to top of outlet tee or baffle:_ « Distance from bottom of scum to bottom of outlet tee or baffle: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) ��3�`<'�'c ['O/�-G�t i GREASE TRAP: (locate on site plan) Depth below grade: -Material of construction: _concrete _metal_FRP—other(explain) Dimensions: Scum.thickness: Distance from top of scum to top of outlet tee or baffle: Qistance from bottom ni 101r".r-.h0t10rn Of OLPIPt 1pe or batue' Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) s !revised 8/15/95) 6 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION.FORM PART C SYSTEM INFORMATION (continued) Property Address: 7b X'N e C�h-�- Owner: W 4, Vti iy Date of Inspection: TIGHT OR HOLDING TANK:/`f (locate on site plan) i Depth below grade: Material of construction: _concrete_,metal _FRP_other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Comments:. (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: (locate on site plan): t C� Depth of liquid level above outlet.invert: Comments: tnoteai ievei and drstributwt. eyuo�, e�;dcnce of so;id: cn:i o%er, evidence of leakage into or out of box, etc.) PUMP CHAMBER:,, (locate on site plan) Pumps in working order.(yes or no) r . Comments: (note;condition of pump chamber, condition of pumps and appurtenances, etc.) (iovised 6/1s/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: '7 p Owner: Date of Inspection:v 6� SOIL ABSORPTION SYSTEM (SAS):y (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined.to be present, explain: Type: leaching pits, number: leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) CESSPOOLS: (locate on site plan) Number and configuration: Depth-top of liquid to inlet:invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of ground,.catc,. inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) �7 PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 6/15/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 7,0 (ZO— L e"l Owner: Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' gat t boo retiTP (� DEPTH TO GROUNDWATER Depth to groundwater: feet method of determination.or approximation: V (Ova w�} ✓ 0S7YueA-i—�j F �� C5 />o�°M (revised 6/i5/95) 9 wV r i�aaa ar.', a a , YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates(cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200•Main St., Hyannis. Take the completed form to the Town Clerk's Office,.1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law_ risk} U,;. {, `� T.,, � _ v DATE: �� f Fill in please: E APPLICANT'S YOUR NAME/S: BUSINESS YOUR HOME ADDRESS: a' wf 'v z �z ew c.R Cry�'ca�✓�� M A 0- 3 ub- �'`" ' " TELEPHONE # Home Telephone Number SO S- i( a37 NAME OF CORPORATION: NAME OF NEW BUSINESS: -TYPE OF BUSINESS o IS THIS.A HOME OCGUPATION� "YE5 NO ADDRESS,OF BUSINESS MAP PARCEL NUMBER Assessin / ( g) ;. When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. r 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: 2. BOARD OF HEALTH t rmi Uir�" e t hat erta'r� o his e o business. This individual he e i �r f he, t typ f u o " Si t r COMMENTS: 9 3. CONSUMER,AFFAIRS(LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature' COMMENTS: